Sense of coherence is a predictor of perceived health in adolescents with congenital heart disease: a cross-lagged prospective study

Abstract

Background: The life expectancy of patients with congenital heart disease (CHD) has increased substantially. Health care should meet their needs through enhancing psychological functioning, quality of life, and perceived health. A possible determinant of these variables is sense of coherence (SOC). The interplay between SOC and outcome variables is not thoroughly scrutinized yet.

Objective: To examine the direction of relationships between SOC and domains of perceived health in adolescents with CHD.

Design: A longitudinal, observational study with two measurement points and a time lag of nine months.

Setting: The pediatric and congenital cardiology department of a university hospital in Belgium.

Participants: Adolescents with CHD (n=429 at time 1) were recruited from the hospital's database. At time 1, mean age was 15.8 years, 53.4% were boys, and most adolescents had a moderately complex heart defect (47.6%).

Methods: Participants filled out the 13-item SOC questionnaire and the PedsQL scale at both time points. Cross-lagged path analysis using structural equation modeling was conducted, controlling for age, sex, educational level, disease complexity, and prior heart surgery for CHD.

Results: SOC at time 1 positively predicted all domains of generic perceived health (physical, emotional, social, and school functioning) and three out of five domains of disease-specific perceived health (symptoms, physical appearance, and cognitive problems) at time 2. Conversely, better school functioning and less cognitive problems at time 1 positively predicted SOC at time 2.

Conclusions: Evidence was obtained for reciprocal pathways between SOC and the domains of perceived health, although the predominant direction of effects was found to be from SOC to perceived health. Hence, improving SOC has the potential to enhance future perceived health of adolescents with CHD.